I am not someone who commonly contacts my therapist between sessions; the resentment I always felt towards those of my father’s clients who did so has heavily enhanced my desire to not be That Client. In fact, I have only done so twice before. Once after a friend of mine killed herself right before a final session before a break, and once, earlier this year, after a session where I was simply overcome with anxiety about having broken A. and feeling sure that I had finally become too much for her, because something in session had made it seem she wasn’t really coping. But, following the session I described in my previous post, in which A. had told me that she couldn’t work with me under the threat of suicide I made a very conscious decision to write her. Below is that email.

*

Dear A.,

It’s late Saturday evening and I find myself feeling like my head is still spinning from trying to make sense of what happened in our last session. I decided already yesterday that I would sit down and try to write down my thoughts over the next few days and send them to you on Sunday; I felt it wouldn’t be a very wise thing to do, sending off a rash email before I have had time to sit with all of this for a little bit. Also, I figure sending it on Sunday gives you two days to think about what I’m saying, should you want me to come for session on Wednesday, so it’s fair on you too.

This is what you said on Friday: ‘I can’t work with you under the threat of suicide’. This is what I heard you saying: ‘I won’t work with you if your level of distress passes a certain point. It’s now got to that stage, and I can’t handle it.’ If I allow my mind to wander a step further it would go something like this: ‘This is too much, too scary, and I don’t want the responsibility. She has become too much for me. I’m out of my depth and I don’t know what to do. I want out, but I don’t want to be the one to end therapy, so I’ll give her a ‘choice’ which is almost impossible to go along with. ‘

I know you said in session that you didn’t know how I might react to what you had to say, but you’re an intelligent person, and it seems reasonable to assume that you must have realised both that this would have a really big impact on me, and have thought of at least one or two scenarios of how I might interpret it. Considering how fear of being ‘too much’ for people and the constant worry about breaking people have been major themes running through the last four years of therapy, it doesn’t take a particularly big leap of the imagination to see that this statement of yours would be experienced as direct proof that I have once again managed to become too much for someone..

Like I said to you in session, this does feel incredibly unfair. In the last four years I have been trying to open up, to stop holding back and to overcome this fear of breaking people – to trust that you can cope, even – and now that I have taken this step, you tell me you can’t work with me. When I have asked you ‘Are you OK? Can you cope [with what I bring to session]?’ you’ve consistently opted to not answer, and then suddenly you give me what you present as a choice, but which to me feels increasingly more and more like a black or white ultimatum. ‘Either you stop being suicidal, or therapy stops’.

I do understand that you are in a very difficult situation and I can easily imagine how very stressful it must be to work with me, especially when I’m dipping like this, I really can. However, I’m not sure exactly what prompted you to make the decision to give me this ultimatum now, because I honestly can’t recall having said anything in the previous session that I haven’t said before. I remember saying that ‘it feels like everyone knows how this is going to end’, but that is something I have said many times in the past.

Were I to venture a guess I would say that it may have been my arriving late for the first session after the break that was the trigger. The fact that you commented on it, makes me think that this was possibly (and, if so, understandably) quite frightening for you, seeing as I had previously made it clear that if I ever don’t show up for a session you’d have good reason to think I’ve taken drastic action. I’m not sure if you believed me when I said that the reason for my lateness was that I used a different route (since I was staying at Drayton Park), and I simply miscalculated how long it would take to get to your place, but that really is the truth. I wouldn’t be so cruel as to be late on purpose solely to test how you’d react, and I would never play games like that with you; I have too much respect both for you as a person and for the work that we do, to do that.

I have to admit that I feel upset about your decision to tell me this on a Friday, knowing that it’s the longest possible time before the next session. I also cannot for the life of me understand why you would wait until after I had been discharged from Drayton Park to have this discussion with me, rather than doing it while I was still there, taking advantage of the fact that I wouldn’t be going home to try to deal with this on my own, but would have people around me who could offer support. This seems especially strange, seeing as I told you that my stay at Drayton Park had been extended until Monday because I knew that the first session back might leave me feeling vulnerable and unstable, since things between you and I had seemed rocky before you went on leave.

As I said before, I can absolutely understand that it must be really hard to deal with me, and it may well have left you feeling you couldn’t cope working under those circumstances, but surely there must have been other ways of doing this? Rather than, for example, making it clear that ‘If you tell me that you are intending to kill yourself, I will have to contact your GP/crisis team/have you sectioned etc..’ (thereby taking some steam off of you), you went straight to ‘If you’re suicidal, I can’t work with you’.

I have no problem with you looking after yourself; if you feel you can’t work with me when things are like this, then – absolutely – you should raise that point. Of course a therapist both needs to and should look after herself, I take no issue with that at all. But, what I do feel has been done quite poorly is the fact that you drop this bomb in my lap without doing anything at all to ensure that I am as safe as possible with it. You could have said ‘If you don’t feel you can make a promise to not kill yourself, I’m really sorry, but I won’t be able to work with you. It would be impossible to do this work. I know this will probably feel like a rejection and I am sorry about that. It’s not my intention to leave you feeling that you have become too much for me, but I do realise that it may have this effect. I may be able to refer you to a colleague, if that is something you would want.’ Or even something so simple as to pick up the phone, call the crisis team, who you knew I was still under, to let them know that you have just had a really difficult conversation with me and you want them to be aware of this as I may need extra support over the weekend.

I really don’t want our work together to end like this, and I certainly don’t want the take away message after four years to be that I’m too much even for the professionals, and that is what it would be, should we terminate therapy at this point. I know you would soon find someone else to take my slot, you’d move on and I would eventually fade and end up being a learning experience for you. I, on the other hand, would be left with the incredibly painful knowledge that I am too much even for professionals, and, really, if even my therapist can’t cope with me, what hope is there..?

I know that some of the things I am writing in this email will inevitably come across as wholly unfair, and I recognise that my assumptions of what is going on for you may well be entirely wrong, but at the end of the day, this is how I have experienced all of this.

You mentioned that I may need some time to think about what you have said and what choice I want to make, and I feel unsure of what the timescale for this is, and whether or not you are expecting me to come to session while I work it out for myself.. I don’t even know if I’m meant to show up on Wednesday or not.

I really do hope that we can talk about this soon and find a way forward, whichever direction that path takes.

xx

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16 responses

Thanks. I think it was wise to take a couple of days to think it through what my feelings about the session and what had been said actually were, so I could write an email that might be a step forward, in terms of honest communication..

I’m so sorry you’re going through this with A. I went through something similar with a therapist I was seeing years ago. My fear was/is that eventually everyone leaves me. But she was someone who I actually liked and could open up to. At that time I really needed to have someone to listen to me, offer me advice, but most of all someone who I could count on to be there for me. Then one day I showed up for my appointment and I was extremely upset and crying. My depression was near it’s lowest and I was barely functioning. After a few minutes into our session, she stated in a manner that showed she was annoyed and frustrated with me, “How can we make any progress if every time you show up you’re in a crisis?” Wasn’t that the reason I was seeing her? I was in a crisis and I needed help. I was finally willing to ask for help which has always been something very difficult for me to do. I didn’t know how to take what she said to me. What was I doing wrong? It must have been me, she’s the professional. I felt like I was being abandoned once again. I left that session and I didn’t go back. Looking back I know I should have went back and talked it out with her. Everyone has a bad day, but at that time I was too messed up to think straight. All I could think about was that I was wasting her time. It took me years to want to try and find another therapist but after my first experience I could never seem to stick to the sessions. After a while I would start missing appointments, then I wouldn’t even bother to call to cancel appointments. I figured that they would drop me like everyone else had done so what was the point. When I’m having good days where I can actually think clearly I realized I was sabotaging myself. So now I don’t see anyone. I go and see my Dr. who writes my prescriptions maybe once every two years. I take my meds and when I’m doing really bad, I’ll either go and see him, or check myself into the hospital. It’s just a shame that sometimes all it takes is one simple sentence to make a patient feel like they just aren’t worth the hassle. One last note about my therapist. One year later she had to leave her job because she had a nervous breakdown! I hope you are having a better day today. Mine is bearable today.

First, let me say that your frankness in dealing with the issue you’ve described here and in your previous post is impressive. My comment is a bit tangential to what you are talking about. As a therapist I have had to deal with patients whose suicidality made therapeutic progress very difficult. At times the “escape valve” of suicide made it difficult for them to invest everything they had (all their psychic energy) in the therapy process. Under those circumstances, we (the patient and I) had to come to an agreement about the way forward. Sometimes it was similar to the agreement you had with your previous therapist. In general the need to take suicide (not suicidal thoughts) out of the patient’s range of options (at least temporarily) was to get him or her to focus on “life” and what they could do to make it better, rather than to keep the focus on “death” or escape from life. In those instances it did not have to do with feeling that the patient was too much for me to handle, but rather to take a different approach to therapy that would increase the chance of progress. I realize that your current therapist did not give you this kind of explanation. My intention here is only to present another way to think about why some therapists try to get suicidality off the table. That is, not only for the obvious reason of wanting the person to live, but also in order to create the possibility of a more effective therapeutic approach. Best of luck in working things out with your current therapist.

Thanks for posting this comment. It sounds like you have had a very bad experience of therapy. I suppose my own general view is that everyone needs therapy, but ONLY when we’re ready for it. I can absolutely see how your first experience put you off searching anyone else out in a hurry, but I think it’s also important to acknowledge your awareness that there was some self-sabotage in subsequent therapies. Such insight is also very valuable. This is exactly why I say that one needs to be ready, in order to gain from the experience. On the other hand, the abandoned therapies, will undoubtedly have been part of the process, and maybe one day you will feel more ready to try therapy again – and most importantly – will find the right person for YOU to do it with. Someone who is sensitive to your specific needs and who speaks the same language as you, if that makes sense.

I agree that a client’s suicidality, especially if it is acute, can make the therapeutic process suffer, may even make it impossible. I also agree that it is fair for a therapist to be clear about not finding a client’s acting out acceptable. However, I feel that the way A. initially presented the issue to me, ie “_I_can’t work under the threat of suicide” suggested in many ways that it wasn’t so much that she felt that my suicidal impulses or acting out was a hindrance to the therapeutic process, as much as it being a case of her being the one who couldn’t work under these circumstances, and this was one of the reasons why I felt that this was perhaps indicative of her not being able to cope. (Along with a number of other things which have given me that impression, particularly in the last six months of us working together). She wasn’t saying that “The constant threat of you acting out makes it impossible for this therapy to happen, because it means your energy is focused more on the idea of being dead, than on being here with me and genuinely engaging with this process.” But, of course it is very possible that I was taking her words a little too literally, maybe expecting too much of her in terms of expressing exactly what she meant in a “perfect” way, and – as I wrote in the email – there is a difference between her actual words and what I heard, and of course the things I read into those words come largely from my imagination – based on my experience both of A. and other similar experiences – rather than from actual, factual knowledge or confirmation from A.

Anyway, I will be posting an update in the next few days, and hopefully that will make it a little more clear what has been going on.

Just to clarify, I wouldn’t presume (for myself) to know what she said or did. You were there, so your insight into what actually happened is worth more than anything I can say. My comment was only to take your experience as a starting point and describe a bit of my own, from my own viewpoint as a therapist. Certainly, I am not here to defend her actions or assume much of anything about them other than what you wrote. I’ll look forward to your update.

Hello
You are immensely brave and mature in the way you have dealt with this.
As I am in the middle of therapy to help me start to live alongside the impact of childhood abuse I can only empathise with what you are experiencing right now.
The thing to be feared most when so much has been invested in the therapeutic relationship has been put on the table.
Highlighting the difference between what you heard and felt and what was said is important. Both of these matter.
In a small way I went through something similar with my therapist when it FELT like she was issuing an ultimatum. The pain was hard to bear.
I hope that you have been able to start a conversation with A. or at least understand better how you might have that conversation.
Since I read your most recent posts I have been thinking about you.
With very best wishes.